Basic Information
| Provider Information | |||||||||
| NPI: | 1902075187 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORSYTH MEMORIAL HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | RHEUMATOLOGY & ARTHRITIS ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 FRONTIS PLAZA BLVD STE 102 | ||||||||
| Address2: | NOVANT MEDICAL GROUP | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271035616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362772435 | ||||||||
| FaxNumber: | 3362779275 | ||||||||
| Practice Location | |||||||||
| Address1: | 291 BROAD ST | ||||||||
| Address2: | DBA RHEUMATOLOGY & ARTHRITIS ASSOCIATES | ||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272842932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367187810 | ||||||||
| FaxNumber: | 3367189374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | EASTERLING | ||||||||
| AuthorizedOfficialFirstName: | PATIRCK | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO & EXECUTIVE VP | ||||||||
| AuthorizedOfficialTelephone: | 7043849094 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FORSYTH MEMORIAL HOSPITAL, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.